Provider Demographics
NPI:1962910836
Name:RICHOUX, KAYLA MOUCH
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MOUCH
Last Name:RICHOUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2414
Mailing Address - Country:US
Mailing Address - Phone:225-267-6626
Mailing Address - Fax:
Practice Address - Street 1:610 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2414
Practice Address - Country:US
Practice Address - Phone:225-267-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily